Rabbi Dr. Aaron Glatt: Covid Update, June 18

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By Rabbi Dr. Aaron E. Glatt, MD

Boruch Hashem, we continue to gradually and successfully reopen NYS, Nassau County, and our local communities and neighborhoods, with Long Island scheduled to enter Phase III Wednesday June 24th.  Unfortunately, this has not been the case everywhere in the country. Arizona, Florida, Oklahoma, Oregon and Texas all reported record increases in new cases – after recording all-time highs last week. Many cities with large Jewish populations, and 22 states overall are going in the wrong direction. It remains unknown why some regions see such startling rises in new COVID-19 cases, whereas others like us, are fortunate to continue with baseline lows. And even when occasional new cases are identified, it has fortunately not led to larger outbreaks.

I will iy”H discuss further expanding our “bubbles”, including how children’s groups and summer camps might impact those decisions, as well as discussing restarting public live non-virtual Torah learning on Motzei Shabbos at 9:45 pm in our usual zoom chat room, Meeting ID: 980 3243 6809; Password: 5TFRBM.

As there are many questions being asked on the chat, I will shorten my presentation and leave more time for Q & A following the talk. For those unable to log on, a live YouTube option will also be provided.
If you are interested in receiving this information, please email president@yiwoodmere.org to get this and other important COVID-19 updates and community announcements.

What important new studies came out this week?
1) The “steroid study” showing decreased death rates in patients with COVID-19 was front page news in the lay press and was read by most people. But what did the study really show? As it is not yet published, I can only comment on what the study investigators themselves announced, which is not the way we usually obtain medical information. This study, called RECOVERY (Randomized Evaluation of COVid-19 thERapY) tested many potential COVID-19 treatments, including dexamethasone, a well-known steroid.

175 hospitals in the UK enrolled 2,104 patients to receive low-dose dexamethasone for ten days compared with 4,321 non-steroid treated otherwise similar patients. Among patients who did not get steroids, mortality was 41% in those requiring a ventilator; 25% in those requiring oxygen; and 13% among those not requiring any respiratory intervention. Dexamethasone reduced deaths by one-third in ventilated patients and by one fifth in patients receiving oxygen only. HOWEVER – there was no benefit among patients not requiring respiratory support.

Based on these results, 1 death would be prevented by treating ~ 8 ventilated patients or ~ 25 patients requiring oxygen alone. (Fortunately, treating with steroids is something we and many hospitals have already been doing for these very sick patients). No benefit would be received (and toxicity would occur) if healthier (i.e. not requiring oxygen) COVID-19 patients were started on steroids.

Bottom Line: Newly diagnosed patient with COVID-19 not requiring supplemental oxygen should NOT be taking steroids without evaluation by a physician; close monitoring of oxygen saturation is essential.

2) A very complex mathematical modeling study published in Nature Medicine from 32 locations in China, Italy, Japan, Singapore, Canada and South Korea provided crucial information regarding children, schools and summer camps. Susceptibility to infection in children under 20 was half that of adults over 20 years old.  Clinical symptoms of COVID-19 manifested in only 21% of those aged 10 – 20 years, versus 69% in people over 70. Wow!

Therefore, interventions aimed at children might have a relatively small impact on reducing transmission, particularly if the transmissibility of asymptomatic infections is lower. These findings suggest that school closures – introduced in many countries as part of lockdowns aimed at controlling the coronavirus pandemic – are likely to have a limited impact on transmission of the disease. Countries (I would possibly add communities) with more young people may thus experience a lower risk of COVID-19 transmission.

3) An MMWR paper updated CDC surveillance data confirming that COVID-19 has more severe outcomes in older adults and those with underlying health conditions.

What is added by this report? As of May 30, 2020, the most common underlying health conditions among COVID-19 cases were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Hospitalizations were six times higher and deaths 12 times higher among those with underlying conditions versus those without.

Hospitalizations and ICU admissions increased with age. Deaths were highest among persons aged ≥70 years, regardless of underlying conditions, and lowest among those aged ≤19 years.

What are the implications for public health practice? These findings highlight the continued need for community mitigation strategies, especially for vulnerable populations, to slow COVID-19 transmission. When people walk around as if COVID-19 is over, they are to a certain extent showing disregard for the health of the older at-risk individuals around them.

4) Final nail in the hydroxychloroquine (HCQ) coffin? The FDA retracted emergency use authorization for HCQ for Covid-19, and simultaneously warned of drug-drug interactions when paired with remdesivir. The FDA noted certain drugs may reduce the antiviral activity of remdesivir, potentially making the drug less effective. Drug-drug interaction trials of remdesivir and other medications have not been conducted in humans. Due to antagonism observed in vitro, concomitant use of remdesivir and HCQ is not recommended.

5) Does blood type make a difference with COVID-19?
New England Journal of Medicine article supported an association between A, B O blood types and COVID-19 outcome based upon other genes that often go along with certain blood types. They detected a novel susceptibility locus at a chromosome 3p21.31 gene cluster and confirmed a potential involvement of the ABO blood-group system in Covid-19. What does this mean in English: Blood group specific analysis showed a slightly higher risk in blood group A than in other blood groups and a slightly protective effect in blood group O.
As an aside, there are severe shortages of blood products to give patients because community blood drives were closed for the past few months. If you are able to donate blood – please consider doing so at any NY Blood Center location or in upcoming community drives that will be opening up shortly.

When can Keilim Mikvaos reopen?
I think that with appropriate social distancing, plus routine handwashing after usage, keilim mikvaos can reopen safely.

What about resuming shiva visits?
At this point, I think this can be done safely too, outdoors, in a limited fashion, if the people sitting shiva feel comfortable from their own risk perspective in doing this. The Rabbonim of the community are working on a safe way to set up such visits.

Is there a concern for a woman to get pregnant during the COVID era?
As opposed to zika, which raised numerous halachic questions regarding birth control, pregnancy avoidance and even abortion shailos, there is NO evidence to suggest that we should revise regular general halachic decisions regarding pregnancy secondary to any COVID-19 concerns. We should im yertza Hashem continue to see numerous semachot in our communities – making shidduchim, engagements, weddings, and beautiful celebrations of healthy children being born without any hesitation – and continue life in this regard despite COVID-19!

COVID-19 “FAQs”:
I am receiving many emails which are often duplicative, so I have put together some FAQs, some of which are straight from the CDC with my slight modifications, and some specific for our community.

Should I go to minyan or go out shopping? I am at “higher risk” because of age or underlying illness…
This is one of the most commonly asked questions. My answer remains the same – no one should feel pressured to do anything they have concerns about. However, if the activity is safe (e.g. a minyan, even indoors, run properly with masks and distancing) then it is a personal choice if you wish to do this. The same thing applies to expanding the bubble – I cannot quantify these risks. Same with the “plane versus car” travel questions. There are too many variables. All I can recommend is to make the risk as low as possible and then decide if it is worth it to you to accept such an increased but low risk.

Should healthcare workers living with someone at higher COVID-19 risk take special precautions?
The CDC recommends no additional precautions are necessary in this setting, although some may choose to implement extra measures when arriving home, such as removing clothing worn during work. Healthcare workers and spouses CAN use the mikvah, CAN go to minyanim, CAN go out in public, etc.

When is someone infectious?
COVID-19 RNA may be detectable in the respiratory tract for weeks after illness; however, detection does not necessarily mean that infectious virus is present. Asymptomatic infection (detection of virus without ever developing symptoms) and pre-symptomatic infections (detection of virus prior to symptoms) occurs, but their role in transmission is not fully understood. Based on existing literature, the incubation period (the time from exposure to development of symptoms) ranges from 2–14 days.

Can people who recover from COVID-19 be re-infected?
The immune response, including duration of immunity, remains not fully understood. Patients are unlikely to be re-infected shortly after they recover, but it remains unknown for how long.

Should post-exposure prophylaxis be used for those exposed to COVID-19?
There is currently no FDA-approved prophylaxis for someone exposed to COVID-19. The exposed person MUST self-quarantine for 14 days. If the exposed individual previously had proven COVID-19 or has true antibodies to COVID-19, the CDC still suggests they follow full quarantine recommendations. However, my personal opinion is that very strict adherence to masking and social distancing without necessarily mandating full self-quarantine is also reasonable.

What does it mean if I have persistent detection of COVID-19 RNA after clinical recovery?
While most recovered persons no longer have detectable RNA, some have persistent positive nasopharyngeal swab tests. This may occur even after testing negative twice; later results can be positive again, and RNA can be detected for up to 6-8 weeks. This is probably just dead genetic material.

Am I contagious if I test persistently or recurrently positive?
It is very unlikely that such persons pose an infectious risk to others. Efforts to isolate live virus from upper respiratory tract specimens have been unsuccessful more than 10 days after illness onset. In addition, there is no evidence that clinically recovered persons with persistent or recurrent detection of viral RNA have transmitted COVID-19 to others.

One more time – what does the presence of antibody exactly mean?
The official CDC position, reiterated again this week, states that there is no firm evidence yet that the antibodies that develop in response to infection are protective. Even if protective, it’s not known what titers are associated with safety from reinfection. I again add however, that there is absolutely no evidence that it is not fully protective, and I do use antibodies as one factor when making decisions and recommendations in certain individual cases.

If an infected person has recovered, do they need a “test of cure”?
No. If symptoms have resolved or are resolving, and they have no fever for at least three days and are more than 14 days from the onset of symptoms, they can resume non-quarantine status.

If an infected person has recovered, do they need to wear a face covering in public?
Yes. It is recommended that almost all persons wear face coverings in public, which should cover the mouth and nose. The primary purpose is to limit transmission from infectious persons who may not have symptoms, or who have early or mild symptoms that they do not recognize. Masks may also offer some protection against exposure, provide reassurance to others in public, and act as a reminder to maintain social distancing. Face coverings should not be placed on children under age 2.

And finally, the most frequent FAQ I am asked – can I “bubble” with or visit so and so?
I am inundated with such questions and it is almost always impossible for me to quantify an answer. Ultimately it is a personal choice. Risk taking is something you must be willing to accept for yourself – I cannot tell you to do so.  The best advice: The smaller the risk, plus the greater the necessity to take it – the more reasonable that choice becomes.

I hope that our current state of relative COVID-19 calm persists. May Hashem continue to shower kindness on those following appropriate masking and social distancing rules, and may no illness occur and spread in those not taking the fullest precautions.

Have a great Shabbos.

18 COMMENTS

    • Anymore? Many knew from the start that all the casualties were from panic attacks (as many gedolim and doctors said) and being hooked up onto ventilators which killed them instantly; from those whom were starved in hospitals and not even given any water; from those who had an underlying sickness; or those who got their flu vaccination which killed their respiratory immune system.

  1. Dear Dr. Glatt,

    After following closely every report i could find (and there were many) regarding hydroxychloroquine, i would like to present to you this question:

    Do you know personally (or, at most, 2nd hand information) of anybody that did the following 3 things and still needed hospitalization and/or died??
    1) Took 200mg hydroxychloroquine tablets twice a day with meals.
    2) Took Zinc tablets (usually 220mg) each time together with the hydroxychloroquine.
    and
    3) Began this regimen within 4 – 5 days of onset of symptoms.

    Note: Every test or study or trial i saw/read that failed, all, without fail, were non-compliant with either # 2 or # 3. Or both.

    If any of the 3 aforementioned instructions were not followed, all bets are off.

    I have yet to come across a single report of failure, when these instructions were implemented .
    (albeit the running consensus of most reports is that hospitalizations were reduced by approximately 90%, and deaths were reduced by 99%. So you may come across some very rare and isolated cases of failure.)

    I work at a Nursing-home here in NYC. We initially had multiple deaths (double-digits).
    However, as soon as our doctors began to initiate the method i enumerated above, there were no more deaths.
    Coincidence, perhaps?

    Hatzlachah!

  2. p.s.
    I forgot to mention, the medication regimen/dosage is for only 5 days. (10 pills hydroxychloroquine total. Accompanied with the 10 Zinc tablets.)

    p.p.s.
    Gutt Shabbos.

  3. Dr glatt one question regarding the uptick in states after opening ,clinically nothing is more wide open than bp for 9 weeks now density, simchos mikvas….so why zero uptick I confirmed w hatzoloh, mimonodies and the yiddish tents sites. What do u make of it?

  4. Positive results to what? To Covid? What EXACTLY is Covid? I don’t trust any doctor and any politician that talk about “Covid symptoms” when it has been proven that Covid is a general term used for every single sickness and illness under the sun; including, or rather, ESPECIALLY Deep State criminal arrests. If he’s a real doctor, let him first tell us what the “Covid symptoms” are instead of parroting the terminology for dumb sheeple that believe it blindly?

  5. As long as the load of serious new cases doesn’t overwhelm hospitals, there is no reason to further destroy the economy.

  6. I find it fascinating that during this entire “Coronavirus” pandemic, not one person died from the flu! Not one person died from Pneumonia.f2f tt

  7. I find it fascinating that during this entire “Coronavirus” pandemic, not one person died from the flu! Not one person died from Pneumonia. Not one person died from a heart attack. Not one person died from a stroke. Only Covid 19 is killing people now. Amazing. We are truly living in one of the most healthiest of times.

  8. I want to be don lechaf zchus here, but so far all we have here is Dr Glatt toeing the party line. Anti HCQ political “studies”, masks for people who have recovered (and thereby are not contagious by definition)?! – Please don’t insult our intelligence with this political nonsense. If I wanted to hear Fauci I wouldn’t need to listen to Glatt. The respect is hard to gain, but easy to loose. The benefit of the doubt is about to evaporate.

  9. It’s critical to understand that there are not just a couple of pharma drugs that are effective in the treatment against Covid-19 but also a natural very safe cheap remedy that’s BOTH a preventative and therapeutic against Covid-19, the proper use of vitamin C — see orthomolecular d ot o r g (click on ‘Library’ and then ‘News Releases’ and read the editions from about February of 2020 on forward)

    A lot of this is based on Nobel laureate Linus Pauling’s pioneering work. HOWEVER….. everyone should keep the following in mind, especially now with the corona scamdemic going on: there are many bogus voices around who strive to distract the public from (1) the value of vitamin C therapy and (2) the fact that Pauling’s VALID work with vitamin C supplementation has been “falsified” by data distortions and lies, and he as a person (a double Nobel laureate) has been slandered as some deluded idiot by the criminal medical establishment and its countless quackwatch shills, lackeys, ignoramuses, and trolls for decades and it continues today — search for the scholarly report “2 Big Lies: No Vitamin Benefits & Supplements Are Very Dangerous” by Rolf Hefti (a published author of the Orthomolecular Medicine News organization). The same corrupt criminal people (and their uninformed followers) are behind the organized suppression, lies, and half-truths spread about the value of vitamin C therapy against covid-19 — see orthomolecular d ot o r g

    But you can’t discredit the facts with lies. That only exposes and discredits the liars (see citations above).

    The fact that we are dealing with a VERY CRIMINAL OFFICIAL POWER STRUCTURE (the Deep State, governments, WHO, official corporate medicine, CDC/Fauci, the mainstream media, paid off scientists, Bill Gates, etc) that constantly hoodwinks the unsuspecting public with MANY BIG LIES can easily be recognized by anyone with two working brain cells when reading this one sentence by a former US government official, Paul Craig Roberts, Ph.D., in his article ‘The Cost of Big Pharma’s Covid-19 Vaccine Will Be Paid in Lives and in Billions of Dollars’:

    “A corrupt establishment and media that can sell us 9/11, Saddam Hussein’s weapons of mass destruction, Iranian nukes, Assad’s use of chemical weapons, a Russian invasion of Ukraine, Russiagate and a large number of other lies can also sell us on locking up a successful treatment in the closet while we await a vaccine.”

    or from another article of his:

    “In “freedom and democracy” America there is only official truth, and it is a lie. […]. […] when I told the truth that Russiagate was a hoax, which it has proved to be, an anonymous website, possibly a CIA or NATO operation called “PropOrNot,” included this website among its fake list of 200 “Russian agents/dupes.” The Washington Post, a believed long-time CIA asset, hyped the PropOrNot revelation as if it were the truth. With “Russiagate” in full hype, the purpose was to scare readers away from those of us who were exposing the hoax. […]. The way those with agendas control the explanations is by shouting down those who provide objective accounts. Social media is part of the censorship. Explanations out of step with official ones are labeled “abusive,” and in “violation of community standards.” In other words, truth is unacceptble. […]. Everyone who uses social media is by their use supporting censorship. Facebook imposes fascist censorship in order to protect official explanations. The presstitutes and universities do the same. In America truth has lost its value. […]. Even a public health threat like coronavirus is politicized. […]. If you are Big Pharma, NIH, CDC, or the research professionals dependent on grants from these sources, you want a vaccine, not a cure. This means a long wait, assuming an effective and safe vaccine is possible. […]. The hydroxychloroquine (HCQ), zinc, and intravenous vitamin C treatments, which have proved to be effective, are badmouthed by Big Pharma and its minions. In other words, the profit agenda over-rides health care and the saving of lives. […]. It is all about money. There are no profits for Big Pharma or a chance for patents for Dr. Fauci unless inexpensive HCQ, zinc, and Vitamin C can be sidelined.”

    Also, if nothing else, watch this MUST-SEE documentary: is d o t gd/uQH5Lb

    And if you still do not think that covid-19 is a planned scamdemic ponder this statement by the American investigative reporter Jon Rappoport:

    “Since planes fly back and forth, and since all sorts of Westerners travel to the rainforests, why haven’t we seen whole native tribes wiped out by viruses from the deep dark streets of Brooklyn? It would even seem that viruses, common in, say, Norway, would cause trouble in Oregon. Why does it have to be “viruses from jungles?” Or other faraway places like China? […]. […] is it possible that jungles and Africa and China are typically chosen for virus fairy tales because, in the minds of many Westerners, they satisfy a requirement of “strange,” “different,” “primitive,” and so on? We’re talking theater here—and when you stage a propaganda play (fiction), you want to tap into the reflex instincts of the audience. The Hartford Virus, the Des Moines Virus, the Vancouver Virus just don’t fit the bill. Because they can’t drive up the fear that jungles or Africa or China can. […]. We NEVER hear killer virus stories about germs traveling from Europe and America to Asia and Africa. Why not? Because such a story won’t sell. It won’t bite. This is called a clue. It tells you that virus-stories are shaped and managed and written and managed and broadcast according to a plan that has nothing to do with actual disease.”

    But having true knowledge like that is not enough in itself, YOUR BEHAVIOR must reflect the implications of that knowledge…. ESPECIALLY NOW IN THE FACE OF THIS MASSIVE EVIL SCAM. As the American social critic Paul Rosenberg pointed out in his article ‘Nothing Changes As Long As You Obey’:

    “I hear the same complaints about politicians that you do. And while I understand them, the fact is that complaining accomplishes almost nothing. And there is a very simple reason why complaining has no real effect: BECAUSE THE COMPLAINERS KEEP RIGHT ON OBEYING. As long as you obey, the things you complain about will keep on happening.”

    And Edmund Burke said:

    “The only thing necessary for the triumph of evil is that good people do nothing.”

  10. With all due respect, Dr. Glatt, I didn’t appreciate the snide remark about puttying a nail in the coffin on HCQ. There are thousands if not tens of thousands who are walking around and not lying in a coffin because of the Zelenko Protocol. I trust Dr. Zelenko more than I trust Fauci and Birx. I find your position very suspicious. Are you hiding behind the Medical and Science Establishment? The truth will triumph at the end and all the liars will be exposed for what they are!! At least, speak to Dr. Zelenko!!!

    • There are thousands that also died because of it, it works both ways
      the issue is dr;s who blindly run towards it or those who do not seek out properly other medications being taken simultaneously which is KNOWN to have adverse effects, needless to mention the lack of base of taking it as a preventative medication

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